Commentary

Article

OptumRx’s Jon Mahrt Discusses “Irresponsible” Drug Pricing for Products With Multiple Indications

When the same product comes to market with additional indications, irrational pricing decisions result in ever-increasing prices instead of volume translating to lower costs, said Jon Mahrt, MBA, of OptumRX.

Novel therapies usually come with high price tags, and it’s important to understand how these treatments impact the total cost of care for a patient, noted Jon Mahrt, MBA, president, pharmacy benefit manager, and chief operating officer, OptumRX.

During an interview for The American Journal of Managed Care® at the Asembia Specialty Pharmacy Summit, held April 28 to May 2 in Las Vegas, Nevada, Mahrt also covered the Inflation Reduction Act and pricing differences for the same product coming to market for different indications, such as the 65% increase in cost for glucagon-like peptide 1s (GLP-1s) first approved to treat diabetes and now for weight loss.

The Senate Committee on Health, Education, Labor, and Pensions recently announced1 it was launching an investigation into the prices of Ozempic, approved for type 2 diabetes,2 and Wegovy, approved for weight loss3 and to prevent heart events4 in patients with cardiovascular disease and excess weight.

Transcript

When it comes to innovative medicines, like GLP-1s, how can or are the additional benefits of potentially avoided health costs later down the line be considered?

Yeah, that's incredibly important. It's really what we're eager to study with not only with our partners in pharma—the pharma manufacturers—but leveraging our health plan data, our medical claims data and the robust suite of analytics to evaluate the impact on total cost of care. I think we're really eager as we look at GLP-1s, specifically, what is on the horizon? Do we see the reduction in in cost of care? Do we see persistence on the drug unlocking future health can benefits. So much to be studied there.

As GLP-1s are studied in additional diseases, such as fatty liver disease, and gain more approvals, can this impact the overall price for all diseases and improve access through insurers?

In theory it should. You know, the unfortunate circumstances we see some irrational, perhaps irresponsible, pricing behavior when these drugs come into the market. And you'll have the same drug come into market under a new brand. The same drug that was treating diabetes now comes in treating obesity or weight loss at a 65% premium. It's the same drug just under a new brand. I think the concern is when you look at those 4 or 5 indications where data is going to be available over the next couple of years, well those drugs would also be introduced with yet another brand, same drug, and yet another price increase for the same drug.

In theory, volume should translate [to lower costs]. If this were purely about manufacturing cost, volume should translate to lower cost. But it's not. There's irresponsible or irrational pricing behavior. Maybe it's due to patent lobbying activity, monopolies over a certain drug or drug class that are driving up the price.

What is your perspective on the impact the Inflation Reduction Act might have on the development of innovative medications in the pipeline?

It's a great question relative to the Inflation Reduction Act. I think that with the Inflation Reduction Act you'll see a focused level of the discipline on the most efficacious drug. You know efficacy will win. Efficacy will prevail. I think you'll see you know manufacturers needing to prioritize their productization [and] commercialization efforts for those drugs that have the greatest impact—they'll be the winners in the market, that won't change so. I think it'll drive toward prioritization around evaluation of efficacy and we'll all win as a result.

References

1. AJMC Staff. What we’re reading: FDA approves UTI antibiotic; Ozempic, Wegovy price investigation; US births fall. The American Journal of Managed Care. April 25, 2024. Accessed April 30, 2024. https://www.ajmc.com/view/what-we-re-reading-fda-approves-uti-antibiotic-ozempic-wegovy-price-investigation-us-births-fall

2. Caffrey M. FDA approves semaglutide, Novo Nordisk’s once-weekly GLP-1 for type 2 diabetes. The American Journal of Managed Care. December 5, 2017. Accessed April 30, 2024. https://www.ajmc.com/view/fda-approves-semaglutide-novo-nordisks-onceweekly-glp1-for-type-2-diabetes

3. Inserro A. FDA clears semaglutide for weight loss when used with diet, exercise. The American Journal of Managed Care. June 4, 2021. Accessed April 30, 2024. https://www.ajmc.com/view/fda-clears-semaglutide-for-weight-loss-when-used-with-diet-exercise

4. Mattina C. FDA approves semaglutide to prevent heart events in patients with CVD and excess weight. The American Journal of Managed Care. March 8, 2024. Accessed April 30, 2024. https://www.ajmc.com/view/fda-approves-semaglutide-to-prevent-heart-events-in-patients-with-cvd-and-excess-weight

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